| NPI | 1831556117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 65365) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60678182) |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2022-07-06 |